Methods and Devices for Manipulating a Vertebra

ABSTRACT

Methods and devices are provided for manipulating a vertebra. In one embodiment, a surgical device can include a frame configured to couple two or more surgical instruments attached to one or more vertebrae. Coupling the two or more surgical instruments together, the frame and/or at least one of the surgical instruments can be manipulated to move at least one of the surgical instruments, thereby effecting movement at least one of the vertebra or vertebrae to which the surgical instruments coupled to the frame are attached. In this way, the surgical device can be used to facilitate rotation of a vertebra relative to another vertebra to correct the angular relationship of the vertebrae.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application claims the priority of U.S. ProvisionalApplication Ser. No. 61/245,108 filed Sep. 23, 2009 entitled “MethodsAnd Devices For Manipulating A Vertebra,” which is hereby incorporatedby reference in its entirety.

FIELD

The present application relates to methods and devices for manipulatinga vertebra.

BACKGROUND

In spinal deformity surgical procedures, the curvature of the spine, forexample, the coronal curvature and/or the sagittal curvature of thespine, can be corrected by the implantation of a construct of boneanchors, e.g., hooks, bone screws, etc., and spinal fixation elements,e.g., rods, tethers, etc. In addition to correcting the curvature of thespine, the angular relationship of one or more vertebrae relative toother vertebrae can also be corrected. Conventional surgical proceduresfor corrected the angular relationship of a vertebra involve rotatingthe spinal fixation element connected to the vertebra by a bone anchor.In the case of constructs including a spinal rod, this procedure istypically referred to as rod derotation. Rod derotation can placesignificant stress on the interface between the bone anchors connectedto the rotated spinal rod and the vertebra in which each bone anchor isimplanted. This stress can cause a failure of one or more of the boneanchors or vertebrae.

Accordingly, there remains a need for methods and devices formanipulating a vertebra.

SUMMARY

In general, methods and devices are provided for manipulating avertebra. In one embodiment, a surgical device is provided that includesa frame having a longitudinal axis extending between opposed first andsecond ends, and a clamping mechanism having a central axis and beingselectively movable between a secured configuration and an unsecuredconfiguration. The clamping mechanism includes a base portion configuredto be selectively positioned and secured at a desired location on theframe along the longitudinal axis of the frame between the first andsecond ends of the frame, and a clamping portion, disposed opposite thebase portion, configured to selectively engage an elongate tubularelement at a desired location along a longitudinal axis of the tubularelement. The clamping mechanism is configured to rotate about thecentral axis thereof relative to the frame when the clamping mechanismis in the unsecured configuration.

The device can have any number of variations. For example, the devicecan also include at least one additional clamping mechanism. For anotherexample, the clamping portion can be substantially c-shaped, which caninclude an arc equal to or greater than about 180°. For yet anotherexample, the clamping portion can include a closed loop. For stillanother example, the clamping mechanism can be removably and replaceablymounted to the frame. For another example, at least the clamping portionof the clamping mechanism can be configured to move relative to theframe in a direction substantially perpendicular to the longitudinalaxis of the frame. For yet another example, the base portion and theclamping portion can be integrally formed. For still another example, adistal end of the elongate tubular member can be configured toreleasably mate to a bone anchor. For another example, the clampingmechanism in the unsecured configuration can be movable along thelongitudinal axis of the frame and can be movable along the longitudinalaxis of the elongate tubular element, and in the secured configurationcan be secured at the desired location on the frame, can be secured atthe desired location along the longitudinal axis of the elongate tubularelement, and can not be rotatable relative to the frame about thecentral axis thereof. The clamping mechanism can be movable alongsubstantially an entire longitudinal length of the frame between theopposed first and second ends. The clamping mechanism can includes a camthat can be actuated by a movable lever and be configured to move theclamping mechanism between the unsecured configuration and the securedconfiguration. The clamping mechanism can include a rotatable knobconfigured to effect movement of the clamping mechanism between theunsecured configuration and the secured configuration.

In another aspect, a surgical system is provided that includes a framehaving a longitudinal axis extending between opposed first and secondends, and a first clamping mechanism having a central axis. The firstclamping mechanism includes a base portion configured to be selectivelypositioned and secured at a desired location on the frame along thelongitudinal axis of the frame between the first and second ends of theframe, and a clamping portion, disposed opposite the base portion,configured to selectively and releasably engage an elongate shaft of afirst instrument at a desired location along a longitudinal axis of theelongate shaft. The first clamping mechanism has an unsecuredconfiguration in which the first clamping mechanism is rotatable aboutthe central axis thereof relative to the frame and is movable relativeto the elongate shaft along the longitudinal axis of the elongate shaft,and has a secured configuration in which the first clamping mechanism isnot rotatable about the central axis thereof relative to the frame andis fixed at the desired location along the longitudinal axis of theelongate shaft.

The system can have any number of variations. For example, the clampingportion can be substantially c-shaped, and the c-shaped portion canextend radially outward from the frame. For another example, the firstclamping mechanism in the unsecured configuration can be selectivelypositionable at the desired location on the frame, and the firstclamping mechanism in the secured configuration can be secured at afixed longitudinal position along the longitudinal axis of the frame atthe desired location on the frame. For yet another example, the firstclamping mechanism can include a cam that can be actuated by a movablelever and be configured to move the first clamping mechanism from theunsecured configuration to the secured configuration. The cam can beconfigured to move the first clamping mechanism from the securedconfiguration to the unsecured configuration. For still another example,the first clamping mechanism can include a rotatable knob configured toeffect movement of the first clamping mechanism from the unsecuredconfiguration to the secured configuration. The rotatable knob can beconfigured to effect movement of the first clamping mechanism from thesecured configuration to the unsecured configuration. For anotherexample, the first clamping mechanism can be removable from the frame.For yet another example, the first clamping mechanism can not beremovable from the frame.

For another example, the system can also include a second clampingmechanism configured to be selectively positioned at a desired locationon the frame along the longitudinal axis of the frame, and configured toreleasably engage an elongate shaft of a second instrument. The secondclamping mechanism has an unlocked configuration in which the secondclamping mechanism is rotatable relative to the frame and is movablerelative to the elongate shaft of the second instrument along alongitudinal axis extending between proximal and distal ends of theelongate shaft of the second instrument, and has a locked configurationin which the second clamping mechanism is not rotatable relative to theframe and is at a fixed longitudinal position along the longitudinalaxis extending between the proximal and distal ends of the elongateshaft of the second instrument. The second clamping mechanism can beremovable or not be removable from the frame. The system can furtherinclude at least one additional clamping mechanism configured to beselectively positioned at a desired location on the frame along thelongitudinal axis of the frame, each additional clamping mechanism beingconfigured to releasably engage an elongate shaft of an additionalinstrument configured to releasably mate to a bone anchor inserted inthe vertebra. Each additional clamping mechanism has an unlockedconfiguration in which it is rotatable relative to the frame and ismovable relative to the elongate shaft of the additional instrumentalong a longitudinal axis extending between proximal and distal ends ofthe elongate shaft of the second instrument, and has a lockedconfiguration in which it is not rotatable relative to the frame and isat a fixed longitudinal position along the longitudinal axis extendingbetween the proximal and distal ends of the elongate shaft of theadditional instrument.

In another embodiment, a surgical system is provided that includes aplurality of bone anchors, at least one spinal fixation elementconfigured to be seated in at least one of the bone anchors, a framehaving a longitudinal axis extending between opposed first and secondends, and a clamping mechanism having a central axis and beingselectively movable between a secured configuration and an unsecuredconfiguration. The clamping mechanism includes a base portion configuredto be selectively positioned and secured at a desired location on theframe along the longitudinal axis of the frame between the first andsecond ends of the frame, and a clamping portion, disposed opposite thebase portion, configured to selectively engage an elongate tubularelement at a desired location along a longitudinal axis of the tubularelement. The elongate tubular element is configured to releasably mateto one of the bone anchors, and the clamping mechanism is configured torotate about the central axis thereof relative to the frame when theclamping mechanism is in the unsecured configuration.

In another aspect, a surgical method for manipulating a vertebra isprovided that includes connecting a first bone anchor to a firstvertebra, connecting a second bone anchor to a second vertebra,positioning a spinal rod in a receiving member of the first bone anchorand in a receiving member of the second bone anchor, connecting a firstinstrument to the first bone anchor, connecting a second instrument tothe second bone anchor, coupling a frame to the first instrument byselectively engaging a first clamping mechanism coupled to the frame ata desired location along a longitudinal axis of the first instrument,the first clamping mechanism being selectively rotatable about a centralaxis of the first clamping mechanism relative to the frame, coupling theframe to the second instrument by selectively engaging a second clampingmechanism coupled to the frame at a desired location along alongitudinal axis of the second instrument, the second clampingmechanism being selectively rotatable about a central axis of the secondclamping mechanism relative to the frame, and moving the frame tomanipulate the first instrument and the second instrument to rotate thefirst vertebra and the second vertebra relative to one another.

The method can vary in any number of ways. For example, the method caninclude, prior to coupling the frame to the first instrument, adjustinga position of the first clamping mechanism along a longitudinal axis ofthe frame between first and second opposed ends of the frame.

In another embodiment, a surgical method for manipulating a vertebra isprovided that includes positioning a first clamp member at a firstlocation between opposed first and second ends of a frame, positioning asecond clamp member at a second location between the opposed ends of theframe, positioning the first clamp member at a first desiredlongitudinal location between opposed proximal and distal second ends ofa first instrument, the distal end of the first instrument being matedto a first bone anchor, positioning the second clamp member at a seconddesired longitudinal location between opposed proximal and distal endsof a second instrument, the distal end of the second instrument beingmated to a second bone anchor, actuating a first actuator integral withthe first clamp member to fix the first clamp member at the firstlocation and at the first desired longitudinal location, and actuating asecond actuator integral with the second clamp member to fix the secondclamp member at the second location and at the second desiredlongitudinal location.

The method can have any number of variations. For example, the methodcan include, prior to positioning the first clamp member at the firstlocation, releasably attaching the first clamp member to the frame. Foranother example, the method can include prior to actuating the firstactuator, rotating the first clamp member about a central axis of thefirst clamp member relative to the frame. For yet another example, thefirst and second bone anchors can be inserted in a vertebral body. Forstill another example, the first and second bone anchors are eachinserted in a different vertebral body. The method can also include,after actuating the first and second actuators, moving the frame to movethe different vertebral bodies relative to one another.

BRIEF DESCRIPTION OF THE DRAWINGS

Methods, devices, and systems described herein will be more fullyunderstood from the following detailed description taken in conjunctionwith the accompanying drawings, in which:

FIG. 1 is a perspective view of one embodiment of a clamping mechanismattached to a frame and in an unsecured configuration;

FIG. 2 is an exploded view of the clamping mechanism of FIG. 1 and theframe of FIG. 1 having a second clamping mechanism attached to the framein an unsecured configuration;

FIG. 3 is a side cross-sectional view of the clamping mechanism of FIG.1;

FIG. 4 is a side view of the clamping mechanism of FIG. 1;

FIG. 5 is a side cross-sectional view of the clamping mechanism of FIG.1 in a secured configuration;

FIG. 6 is a side view of the clamping mechanism of FIG. 5;

FIG. 7 is a perspective view of the clamping mechanism and frame of FIG.1 attached to surgical instruments coupled to a vertebra, with anadditional clamping mechanism attached to the frame and with each of theclamping mechanisms in secured configurations;

FIG. 8A is a perspective view of another embodiment of a clampingmechanism attached to a frame in a secured configuration;

FIG. 8B is a side, partially transparent view of the clamping mechanismand frame of FIG. 8A with the clamping mechanism in an unsecuredconfiguration;

FIG. 8C is a side, partially transparent view of the clamping mechanismand frame of FIG. 8A with the clamping mechanism in an securedconfiguration;

FIG. 8D is a perspective view of two clamping mechanisms and frames ofFIG. 8A coupled to a surgical instrument with the clamping mechanisms insecured configurations;

FIG. 8E is a top view of another embodiment of a clamping mechanismattached to a frame with the clamping mechanism in a secured positionand coupled to a surgical instrument;

FIG. 8F is a perspective view of the clamping mechanism, frame, andsurgical instrument of FIG. 8E;

FIG. 8G is a perspective view of the clamping mechanism of FIG. 8Aattached to frame and the clamping mechanism of FIG. 8E attached to theframe;

FIG. 9 is a perspective view of another embodiment of a clampingmechanism attached to a frame in an unsecured configuration;

FIG. 10 is a perspective, cross-sectional view of the clamping mechanismand frame of FIG. 9;

FIG. 11 is an exploded view of another embodiment of a clampingmechanism attached to a frame and a second clamping mechanism attachedto the frame;

FIG. 12 is a perspective view of one embodiment of a modular clampingmechanism attached to a frame in an unsecured configuration;

FIG. 13 is another perspective view of the modular clamping mechanismand frame of FIG. 12;

FIG. 14 is a perspective view of the modular clamping mechanism of FIG.12 in an open configuration and unattached to the frame;

FIG. 15 is an exploded view of the modular clamping mechanism of FIG. 12and the frame of FIG. 12;

FIG. 16 is a perspective, cross-sectional view of the modular clampingmechanism and frame of FIG. 12;

FIG. 17 is a perspective view of another embodiment of a modularclamping mechanism in a closed configuration and attached to a frame;

FIG. 18 is a perspective view of the modular clamping mechanism of FIG.17 in an open configuration and unattached to the frame;

FIG. 19 is a perspective view of one embodiment of a depth-adjustingclamping mechanism attached to a frame; and

FIG. 20 is a perspective view of another embodiment of a depth-adjustingclamping mechanism attached to a frame with the clamping mechanism ofFIG. 8E attached to the frame and clamping a surgical instrument.

DETAILED DESCRIPTION

Certain exemplary embodiments will now be described to provide anoverall understanding of the principles of the structure, function,manufacture, and use of the devices and methods disclosed herein. One ormore examples of these embodiments are illustrated in the accompanyingdrawings. Those skilled in the art will understand that the devices andmethods specifically described herein and illustrated in theaccompanying drawings are non-limiting exemplary embodiments and thatthe scope of the present invention is defined solely by the claims. Thefeatures illustrated or described in connection with one exemplaryembodiment may be combined with the features of other embodiments. Suchmodifications and variations are intended to be included within thescope of the present invention.

Various exemplary methods and devices are provided for manipulating avertebra. Generally, a surgical device can include a rack, frame, orconnector, generally referred to herein as a “frame,” configured tocouple two or more surgical instruments attached to one or morevertebrae. Coupling the two or more surgical instruments together, theframe and/or at least one of the surgical instruments can be manipulatedto move at least one of the surgical instruments, thereby effectingmovement at least one of the vertebra or vertebrae to which the surgicalinstruments coupled to the frame are attached. In this way, the surgicaldevice can be used to facilitate rotation of a vertebra relative toanother vertebra to correct the angular relationship of the vertebrae.

The frame can be configured to couple two or more surgical instrumentsvia two or more clamping mechanisms movably attached to the frame. Atleast one of the clamping mechanisms can be configured to translatelongitudinally along a longitudinal length of the frame to allow forx-axis or horizontal adjustment of the clamping mechanism, to radiallymove relative to the frame to allow for z-axis or depth adjustment ofthe clamping mechanism, and/or to be positionable at any location alonga longitudinal length of the surgical instrument to provide flexibilityin y-axis or vertical positions of the clamping mechanism relative tothe surgical instrument. In this way, the clamping mechanisms can bepositioned in a wide variety of positions to most securely attach tosurgical instruments, which can correspondingly be positioned in a widevariety of positions relative to a patient's body. At least one of theclamping mechanisms can be configured as a modular component removablefrom and replaceable on the frame to allow for any number of clampingmechanisms to be selectively coupled to the frame as desired for aparticular surgical application using a plurality of surgicalinstruments. Modular components can also allow for the frame to be freeof unused clamping mechanisms, thereby providing increased space forsurgical maneuverability and/or visibility.

In an exemplary embodiment, shown in FIGS. 1 and 2, a surgical device 10includes a frame 12 and first and second clamping mechanisms 14 a, 14 bcoupled to the frame 12. Although two clamping mechanisms 14 a, 14 b areshown coupled to the frame 12, a person skilled in the art willappreciate that any number of clamping mechanisms, same or differentfrom one another, can be attached to the frame 12. Generally, the device10 can be configured to connect one or more surgical instruments and, ifconnected to multiple surgical instruments, to facilitate cooperativemovement of the surgical instruments. In an exemplary embodiment thedevice 10 can connect one or more surgical instruments for manipulatinga vertebra, as discussed further below, although a person skilled in theart will appreciate that the device 10 can be used to connect any typeof spinal or surgical instruments.

The frame 12 and the clamping mechanisms 14 a, 14 b can each have avariety of sizes, shapes, and configurations. The frame 12 and theclamping mechanisms 14 a, 14 b can be formed of any one or morematerials, same or different from material(s) used to form any other ofthe frame 12 and clamping mechanisms 14 a, 14 b. In an exemplaryembodiment the device 10 is formed of one or more biocompatible,substantially rigid materials such as metal alloys, stainless steel,titanium, polymers, and ceramics.

As in the illustrated embodiment, the frame 12 can include an elongatebar or rod having opposed first and second ends 16 a, 16 b with opposedfirst and second sidewalls 18 a, 18 b extending therebetween. Theopposed ends 16 a, 16 b can each be curved, as shown, to help preventthe frame 12 from snagging on or otherwise damaging the surgical site orother surgical instruments. The sidewalls 18 a, 18 b can define achannel, slot, or slit 20, generally referred to as a “channel,”extending through the frame 12 and between the sidewalls 18 a, 18 balong a longitudinal axis 12A and a longitudinal length 12L of the frame12 between the opposed ends 16 a, 16 b such that the frame 12 has anelongate o-shape. In another exemplary embodiment, a channel can extendalong a partial longitudinal length of the frame 12 such that theclamping mechanisms 14 a, 14 b can only move along a partiallongitudinal length of the frame 12. In yet another exemplaryembodiment, the frame 12 can include a plurality of channels eachextending along a partial longitudinal length of the frame 12. One ormore clamping mechanisms can be attached to the frame 12 in each of thechannels, e.g., one clamping mechanism per channel, for slidablemovement therein as discussed further below.

The channel 20 in the illustrated embodiment of FIGS. 1 and 2 is smoothand free of obstructions to allow free slidable movement of the clampingmechanisms 14 a, 14 b therein, as discussed further below, but thechannel 20 can optionally include a textured, frictional surface and/ora plurality of obstructions, e.g., teeth, notches, depressions, etc.configured to allow step or incremental movement of the clampingmechanisms 14 a, 14 b. In such a case, the clamping mechanisms 14 a, 14b can include complementary obstructions, e.g., protrusions configuredto engage depressions formed in the sidewalls 18 a, 18 b and facing thechannel 20, such that the clamping mechanisms 14 a, 14 b are configuredto be positioned at a plurality of predefined positions within thechannel 20. The channel 20 can additionally or alternatively include oneor more stop mechanisms formed therein, e.g., protrusions extendingradially inward from one or both of the sidewalls 18 a, 18 b, and beingconfigured to prevent slidable, longitudinal movement of a clampingmechanism when the clamping mechanism abuts the stop mechanism.

As mentioned above, the clamping mechanisms 14 a, 14 b can have avariety of sizes, shapes, and configurations and can generally beconfigured to move along a longitudinal axis 12A of the frame 12 and toattach to a surgical instrument. The clamping mechanisms 14 a, 14 b inthe embodiment shown in FIG. 1 are identical, but a person skilled inthe art will appreciate that clamping mechanisms coupled to the frame 12can be the same or different from any one or more other clampingmechanisms coupled to the frame 12.

The first clamping mechanism 14 a can include a base portion and aclamping portion. The base portion can be configured to be selectivelypositioned and secured at a desired location on the frame 12 along thelongitudinal axis 12A of the frame 12 between the first and second ends16 a, 16 b of the frame 12. The clamping portion can be disposedopposite the base portion and can be configured to selectively engage asurgical instrument, e.g., an elongate tubular element or elongateshaft, at a desired location along a longitudinal axis of theinstrument. The base portion and the clamping portion can be integrallyformed, as in the illustrated embodiment of FIGS. 1 and 2, or they canbe separable elements. Components of the base portion and the clampingportion of the first clamping mechanism 14 a are discussed below asnon-limiting examples only, and as will be appreciated by a personskilled in the art, can each include a variety of components.

The first clamping mechanism 14 a can include, as shown in theembodiment of FIGS. 1 and 2, a plate 22 positioned distal to a distalside 12D of the frame 12, and a washer or nut 24, generally referred toas a “washer,” can be positioned distal to the plate 22. A cam orcarriage 26, generally referred to as a “carriage,” can be positionedproximal to a proximal side 12P of the frame 12. The plate 22 and thecarriage 26 can be configured to be selectively movable relative to theframe 12 such that with the plate 22 and the carriage 26 in a first,unsecured configuration the first clamping mechanism 14 a can belongitudinally slidable within the channel 20, and with the plate 22 andthe carriage 26 in a second, secured configuration the first clampingmechanism 14 a can be longitudinally non-movable at a fixed positionalong the frame's longitudinal axis 12A. The base portion of the firstclamping mechanism 14 a in the illustrated embodiment can thus includethe washer 24 and the carriage 26, each being configured to contact theframe's sidewalls 18 a, 18 b and be selectively locked and unlocked theframe's sidewalls 18 a, 18 b to selectively, respectively, prevent andallow movement of the first clamping mechanism 14 a relative to theframe 12 along the frame's longitudinal axis 12A.

The first clamping mechanism 14 a can also include an outer shell 28 andan inner shell, yoke, or clamp 30, generally referred to as a “clamp,”configured to be proximal to and seated in the outer shell 28. The outershell 28 can be positioned proximal to the carriage 26, with a distallyextending cannulated shaft 28S extending into a bore 26B formed in thecarriage 26. A distally extending shaft 30S of the clamp 30 can extendthrough a bore 28B formed through the outer shell 28, through thecarriage's bore 26B, through the frame's channel 20, and into bores 22B,24B respectively formed in the plate 22 and the washer 24. The washer 24can be attached to a desired location of the clamp's shaft 30S, e.g.,welded to the clamp's shaft 30S during manufacture of the first clampingmechanism 14 a, such that the clamp 30 proximally extends a desireddistance beyond the frame's proximal side 12P. In this way, the clamp 30can help nonremovably secure the first clamping mechanism 14 a to theframe 12. The plate 22 also helps nonremovably secure the first clampingmechanism 14 a to the frame 12 as discussed further below. Although theclamping mechanisms 14 a, 14 b in this illustrated embodiment arenonremovably attached to the frame 12, as discussed further below, insome embodiments, one or more clamping mechanisms coupled to the frame12 can be releasably and replaceably attachable to the frame 12. Theclamping portion of the first clamping mechanism 14 a can thus includethe clamp 30 configured to contact a surface of a surgical instrumentand to be releasably attached thereto in a fixed position.

The clamp 30 can have a variety of sizes, shapes, and configurations. Inthe illustrated embodiment, the clamp 30 is substantially c-shaped asdefined by arms 30M of the clamp 30 that extend in a proximal directionradially outward from the frame 12. An inner surface of the arms 30M canbe configured to engage a corresponding substantially c-shaped surfaceof the outer shell 28, and an outer surface of the arms 30M can beconfigured to engage a surgical instrument and attach thereto asdiscussed further below. To help ensure that the arms 30M can securelyhold a surgical instrument, the arms 30M can form an arc equal to orgreater than about 180°. In the illustrated embodiment of FIGS. 1 and 2,the arms 30M form a 180° arc of a semi-circle. A person skilled in theart will appreciate that the clamp 30 can have another shape, such ashaving a closed loop in the form of a circle, an ellipse, a rectangle,etc.

The arms 30M can optionally include a stop mechanism, e.g., protrusions,flared terminal ends 30T, etc., and/or optionally include a grippingfeature, e.g., a textured surface, slits 30L, etc., extending along atleast a partial longitudinal length of an outer, facing surface the arms30M. As discussed further below, the stop mechanism can be configured tofacilitate seating of the clamp 30 in the outer shell 28, and thegripping mechanism can be configured to facilitate a secure,non-slipping hold of a surgical instrument.

The first clamping mechanism 14 a can also include an actuator, e.g., alever 32 that includes a cam 32 b located at terminal ends of the lever32, configured to selectively lock and unlock the first clampingmechanism 14 a to the frame 12. The lever 32 can be movable between twopositions corresponding to locked and unlocked configurations of thefirst clamping mechanism 14 a. As shown, the lever 32 can be pivotallyattached to the outer shell 30 with two pins 34 on opposed sides of theouter shell 30 and opposed sides of the lever 32. Pivotally moving thelever 32 from an open position, shown in FIGS. 1, 3, and 4, to a closedposition, shown in FIGS. 5 and 6, can enable the cam 32 b to move thefirst clamping mechanism 14 a from an unsecured, unlocked, or movableconfiguration, generally referred to as an “unsecured configuration,” toa secured, locked, or fixed configuration, generally referred to as a“secured configuration.” The lever 32 can be configured to fixedly lockin the secured configuration or can, as in the illustrated embodiment,be configured to be selectively movable any number of times between theclosed and open positions to selectively move the first clampingmechanism 14 a between the secured and unsecured configurations.

In the unsecured configuration, shown in FIGS. 1, 3, and 4, the firstclamping mechanism 14 a can be configured to be movable relative to theframe 12 in at least one plane. In the illustrated embodiment, the firstclamping mechanism 14 a is movable in two planes relative to the frame12. First, the first clamping mechanism 14 a can be configured to slidealong the frame's longitudinal axis 12A between the frame's opposed ends16 a, 16 b to allow adjustment of a horizontal position of the firstclamping mechanism 14 a. To facilitate slidable movement of the firstclamping mechanism 14 a, the plate 22 can be seated in a groove,internal channel, or slot 36, generally referred to as a “groove,” thatcan extend along the frame's longitudinal length 12L and can be formedin an inner surface of the sidewalls 18 a, 18 b facing the channel 20and also optionally in an inner surface of the opposed ends 16 a, 16 bfacing the channel 20. With the first clamping mechanism 14 a in theunsecured configuration, the plate 22 can be configured to be freelyslidable within the groove 36. A spring 38 disposed in the bore 28B ofthe outer shell 28 and disposed around the clamp's shaft 30S can beconfigured to bias the outer shell 28, and hence also the clamp 30seated therein, away from, e.g., proximal to, the frame 12. Such outwardbiasing can help prevent the clamp 30 from interfering with slidable,longitudinal movement of the first clamping mechanism 14 a. Second, thefirst clamping mechanism 14 a can be configured to rotate about acentral axis 14C of the first clamping mechanism 14 a, e.g., alongitudinal axis extending centrally through the clamp's shaft 30S andthe first clamping mechanism's various bores 22B, 24B, 26B, 28B, toallow adjustment of clamp's clamping portion relative to a surgicalinstrument to which it will be attached. The first clamping mechanism'scentral axis 14C can be substantially perpendicular to the frame'slongitudinal axis 12L, as in the illustrated embodiment, which can helpallow 360° clockwise and/or counterclockwise rotation of the firstclamping mechanism 14 a without any interference from the frame 12. Inthe illustrated embodiment, a portion of the first clamping mechanism 14a is rotatable, e.g., the washer 24, the outer shell 28, the clamp 30,the lever 32, the pins 34, and the spring 36, about the first clampingmechanism's central axis 14C, but in another embodiment an entireclamping mechanism can be configured to rotate about its central axisrelative to the frame 12. Although the clamp's shaft 30S has threadsformed on its distal end that can engage corresponding threads on thewasher 24, the shaft 30S is not threadable relative to the washer 24except during manufacturing when the washer 24 and the shaft 30S can bethreadably adjusted to adjust a proximal distance of the substantiallyc-shaped clamp 30 from the frame 12 as discussed above. In anotherembodiment, the clamp's shaft 30S and the washer 24 are not threadedand/or are integrally formed.

In another embodiment, as discussed further below, a clamping mechanismin the unsecured configuration can additionally or alternatively bemovable toward and away from the proximal side 12P of the frame 12 indirection substantially perpendicular to the frame's longitudinal axis12A, which can also allow adjustment of clamp's clamping portionrelative to a surgical instrument to which it will be attached.

In the secured configuration, shown in FIGS. 5 and 6, the first clampingmechanism 14 a can be configured to be in a fixed position relative tothe frame 12, e.g., no longer be movable in the one or more planes inwhich the first clamping mechanism 14 a was movable in the unsecuredconfiguration. In the secured configuration the clamp 30 of the firstclamping mechanism 14 a can also be configured to securedly hold asurgical instrument as discussed further below.

The first clamping mechanism 14 a can be moved between the unsecured andsecured configurations by actuating the lever 32, e.g., by pivotallymoving the lever 32 about the pins 34 to cause the cam 32 b to rotateover an outer surface 26S of the carriage 26. To move the first clampingmechanism 14 a from the unsecured configuration to the securedconfiguration, the lever 32 can be pressed down, e.g., distally towardthe proximal side 12P of the frame 12. Similarly, to move the firstclamping mechanism 14 a from the secured configuration to the unsecuredconfiguration, the lever 32 can be moved up, e.g., proximally away fromthe proximal side 12P of the frame 12.

As mentioned above, in the secured configuration, the first clampingmechanism 14 a can be prevented from moving in the one or more planes ofmotion in which it was movable in the unsecured configuration. The firstclamping mechanism 14 a can be prevented from sliding along the frame'slongitudinal axis 12A in the secured configuration through movement ofthe plate 22 to engage a wall of the groove 36 in which it is disposed.Tension between the carriage 26 and the plate 22 with the frame 12squeezed therebetween can thereby prevent longitudinal translation ofthe first clamping mechanism 14 a along the frame 12. The first clampingmechanism 14 a can be prevented from rotating about its central axis 14Cin the secured configuration because the lever 32 can have an outer,distal surface 32S configured to engage and correspond in shape to theouter surface 26S of the carriage 26. In this way, the lever 32 can cliparound the carriage 26 in the closed position, thereby preventingrotation of the first clamping mechanism 14 a relative to the frame 12.

Moving the lever 32, and rotating the cam 32 b, to the closed positioncan also counteract the force provided by the spring 38 and compress thespring 38. Compression of the spring 38 can cause the outer shell 28 toproximally move a distance D away from the outer surface 26S of thecarriage 26 which the outer shell 28 can contact when the first clampingmechanism 14 a is in the unsecured position. The proximal or upwardmovement of the outer shell 28 can cause compression of the clampingportion of the clamp 30, e.g., compress the arms 30M together. Theflared terminal ends 30T of the clamp 30 can help prevent the outershell 28 from proximally moving too far and to help compress the arms30M inward, which can facilitate a strongly grip of a surgicalinstrument positioned within the substantial c-shape defined by the arms30M. A well 30W formed in a central portion of the clamp 30 proximallyextending through the clamp 30 to a position proximal to a distal end ofthe clamp 30 can help allow movement of the arms 30M toward one another.The slits 30L in the arms 30M can allow the arms 30M to compensate forany irregularities in an outer surface of the surgical instrument whichthey are compressed around to hold because each the portions of the arms30M on either side of the slit 30L can compress a different amount. Inthe illustrated embodiment the first clamping mechanism 14 a isconfigured to hold a surgical instrument in a fixed position relative tothe first clamping mechanism 14 a. In another embodiment, a clampingmechanism can be configured to allow polyaxial motion of the surgicalinstrument when the first clamping mechanism 14 a is attached thereto.By way of non-limiting example, a clamping portion of a clampingmechanism can include a partially spherically shaped surface thatdefines a seat or engagement surface for a surgical instrument, e.g., apartially spherically shaped connection element formed on a shaft of thesurgical instrument. Exemplary embodiments of complementary partiallyspherical shaped elements allowing polyaxial motion of a surgicalinstrument are described in more detail in U.S. Patent Publication No.2006/0200132 entitled “Instruments And Methods For Manipulating AVertebra” filed on Mar. 4, 2005, which is hereby incorporated byreference in its entirety.

In use, as shown in an exemplary embodiment in FIG. 7, the clampingmechanisms 14 a, 14 b of the surgical device 10 can be respectivelycoupled to first and second surgical instruments 40 a, 40 b respectivelyattached to first and second bone anchors 42 a, 42 b inserted in a firstvertebra 44. Generally, a size and shape of outer diameters of the firstand second surgical instruments 40 a, 40 b can correspond to a size andshape of the arms of the clamping mechanisms 14 a, 14 b to allow theclamping mechanisms 14 a, 14 b to interchangeably attach to the surgicalinstruments 40 a, 40 b as discussed above. The first and second surgicalinstruments 40 a, 40 b are illustrated as elongate, cylindrical tubularelements having elongate, cylindrical shafts with distal ends configuredto releasably engage the bone anchors 42 a, 42 b. The first surgicalinstrument 40 a in this embodiment has a substantially constant outerdiameter along a longitudinal length of its shaft between proximal anddistal ends of the first surgical instrument 40 a, which can allow thefirst clamping mechanism 14 a, or any other additional or alternativeclamping mechanism(s), to grip the first surgical instrument 40 a at anylocation along its longitudinal length. The second surgical instrument40 b in this embodiment has a substantially constant outer diameteralong a proximal portion thereof and an enlarged outer diameter along adistal portion thereof. The second clamping mechanism 14 b, or any otheradditional or alternative clamping mechanism(s), can thus grip thesecond surgical instrument 40 b at any location along its longitudinallength in the proximal portion thereof. As will be appreciated by aperson skilled in the art, the first and second surgical instruments 40a, 40 b can have any size, shape, and configuration, same or differentfrom one another. Exemplary embodiments of surgical instruments aredescribed in more detail in previously mentioned U.S. Patent PublicationNo. 2006/0200132 entitled “Instruments And Methods For Manipulating AVertebra” filed on Mar. 4, 2005, and in U.S. Pat. No. 7,179,261 entitled“Percutaneous Access Devices And Bone Anchor Assemblies” issued Feb. 20,2007, which is hereby incorporated by reference in its entirety.

The illustrated first and second bone anchors 42 a, 42 b are identicaland include elongate threaded shafts (not show) distally extending froma proximal heads having grooves formed therein configured to receivespinal fixation elements (not shown), e.g., spinal rods. However, aswill be appreciated by a person skilled in the art, any bone anchors,same or different from one another, configured to engage bone and seat aspinal fixation element can be used in a surgical system including anyof the surgical devices described herein. Exemplary embodiments of boneanchors are described in more detail in previously mentioned U.S. PatentPublication No. 2006/0200132 entitled “Instruments And Methods ForManipulating A Vertebra” filed on Mar. 4, 2005 and U.S. Pat. No.7,179,261 entitled “Percutaneous Access Devices And Bone AnchorAssemblies” issued Feb. 20, 2007, and in U.S. Patent Publication No.2006/0200131 entitled “Constrained Motion Bone Screw Assembly” filedMar. 4, 2005, which is hereby incorporated by reference in its entirety.

With both of the first and second clamping mechanisms 14 a, 14 b beinglongitudinally translatable along the frame 12, the first and secondclamping mechanisms 14 a, 14 b can be better positioned to attach to thesurgical instruments 40 a, 40 b and the frame 12 can be betterpositioned for manipulation and for avoiding interference with otheraspects of the surgical procedure. Similarly, with both of the first andsecond clamping mechanisms 14 a, 14 b being rotatable about theirrespective central axes, the first and second clamping mechanisms 14 a,14 b can be better positioned to attach to surgical instruments 40 a, 40b. In this illustrated embodiment, the first clamping mechanism 14 a hasbeen rotated about 180° relative to the frame 12 from the position shownin FIG. 1 such that the lever 32 faces the first end 16 a of the frame12 rather than the second end 16 b.

When the first and second clamping mechanisms 14 a, 14 b are atdesirable positions relative to the frame 12 and the respective surgicalinstruments 40 a, 40 b to which they will be clamped, the levers of therespective first and second clamping mechanisms 14 a, 14 b can be movedfrom open positions to closed positions to move the first and secondclamping mechanisms 14 a, 14 b from unsecured positions to securedpositions. The first and second clamping mechanisms 14 a, 14 b can besimultaneously moved from unsecured positions to secured positions or besequentially moved from unsecured positions to secured positions, witheither clamping mechanism 14 a, 14 b moved first. One of the first andsecond clamping mechanisms 14 a, 14 b can be adjusted in the unsecuredposition and moved to the secured position before the other of the firstand second clamping mechanisms 14 a, 14 b is adjusted in the unsecuredposition.

With the first and second clamping mechanisms 14 a, 14 b in securedconfigurations and attached to the first and second surgical instruments40 a, 40 b, respectively, at substantially the same axial position, theframe 12 can be substantially linear such that the frame 12 issubstantially perpendicular to the surgical instruments 40 a, 40 b, asshown in FIG. 7. Because the first and second clamping mechanisms 14 a,14 b can be selectively positioned along longitudinal axes 40 aL, 40 bLof the first and second surgical instruments 40 a, 40 b, respectively,in another exemplary embodiment the clamping mechanisms 14 a, 14 b canbe positioned at different axial positions such that the frame 12 can bepositioned at an angle relative to the surgical instruments 40 a, 40 b,e.g., with the frame's longitudinal axis 12A and the surgicalinstruments' longitudinal axes 40 aL, 40 bL being non-perpendicular.Such varied positioning of the clamping mechanisms 14 a, 14 b can allowthe surgical device 10 to be used with a variety of surgical instrumentshaving different sizes, shapes, and configurations. Additionally, suchangled positioning of the frame 12 can facilitate convenient positioningof the frame 12, e.g., to avoid obstructions such as other surgicalinstruments, to allow improved visibility of a surgical site, etc.

Although the surgical instruments 40 a, 40 b are inserted in the samevertebra 44 in the embodiment illustrated in FIG. 7, a person skilled inthe art will appreciate that the surgical instruments 40 a, 40 b can beinserted into any number of adjacent or non-adjacent vertebrae. A personskilled in the art will also appreciate that only one surgical device 10is shown, a plurality of surgical devices 10 can be used to interconnecta plurality of surgical instruments attached to a plurality of boneanchors to create an interconnected system. By way of non-limitingexample, a third clamping mechanism (not shown) on a second frame (notshown) can be connected to the first surgical instrument 40 a, and afourth clamping mechanism (not shown) on the second frame can beconnected to a third surgical instrument (not shown) connected to athird bone anchor 42 c inserted in a second vertebra 44 b adjacent tothe first vertebra 44. In this way, manipulation of either of the firstand second frames and any of the surgical instruments coupled to thefirst and second frames can effect movement of both the first and secondvertebra 44, 44 b to which the first and second frames are coupled.

FIGS. 8A-8D and 8G illustrate another exemplary embodiment of a frame112 and a clamping mechanism 114 having an actuator in the form of alever 132. In this embodiment, the clamping mechanism 114 includes aT-shaped base portion 115, having the lever 132 coupled to a terminalend thereof, and a substantially c-shaped clamping portion in which asurgical instrument 140 can be side loaded, e.g., advanced through anopening defined by opposed arms 130 a, 130 b of the clamping mechanism114 and into a recess 117. Pushing the lever 132 to move the lever 132from an open position, shown in FIG. 8B, to a closed position, shown inFIGS. 8A, 8C, and 8D, can move the clamping mechanism 114 from anunsecured configuration to a secured configuration similar to thatdescribed above.

FIGS. 8E-8G illustrate yet another exemplary embodiment of a frame 212and a clamping mechanism 214 having an actuator in the form of a lever232. The clamping mechanism 214 is similar to the side loading clampingmechanism 114 of FIGS. 8A-8D. In this embodiment, the lever 232 can beactuated by twisting or rotating the lever 232 rather than throughpush-pull movement. Twisting the lever 232 in a first direction, e.g.,clockwise, can move the clamping mechanism 214 from the unsecuredconfiguration to the secured configuration, while twisting the lever 232in a second, opposite direction, e.g., counterclockwise, can move theclamping mechanism 214 from the secured configuration to the unsecuredconfiguration.

In another exemplary embodiment, shown in FIGS. 9 and 10, a clampingmechanism 314 nonremovably attached to a frame 312. The frame 312, aswell as other frames described herein, can be configured and usedsimilar to the frame 12 of FIGS. 1-7 discussed above. The clampingmechanism 314 can generally be configured and used similar to the firstclamping mechanism 14 a of FIGS. 1-7 discussed above. Similar to thefirst clamping mechanism 14 a of FIGS. 1-7, the clamping mechanism 314includes a carriage 326, an outer shell 328, a spring 338, and asubstantially c-shaped clamp 330 having a slit 330L formed in arms 330Mthereof with the arms 330M having flared terminal ends 330T. However, inthis embodiment, the clamping mechanism 314 includes an actuator in theform of a rotatable knob 333. The knob 333 can be configured to rotatein a first direction, e.g., clockwise, to move the clamping mechanism314 from a secured configuration to an unsecured configuration, and in asecond, opposite direction, e.g., counterclockwise, to move the clampingmechanism 314 from the unsecured configuration to the securedconfiguration.

In the illustrated embodiment, a shaft 330S of the clamp 330 includesthreads 330H in a distal portion thereof similar to the shaft 30S of theclamp 30 in FIGS. 1-7, but in this embodiment the shaft's threads 330Hcan engage and rotate within corresponding threads 333H formed in theknob 330. In this way, the knob 330 can rotate relative to the clamp 330around a central axis 314C of the clamping mechanism 314 to move theclamping mechanism 314 between unsecured and secured configurations. Theclamping mechanism 314 can include a locking mechanism, e.g., a stopbar, nut, washer, or plate 335, generally referred to as a “stop nut,”disposed at a distal end of the shaft 330S and contained within a cavity333C in the knob 333. The locking mechanism can be configured tononremovably secure the knob 333 to the shaft 330S. When the knob 333 ismoved to an open position by rotating distally or down, e.g., away fromthe frame 312, the stop nut 335 can engage a proximal surface of thecavity 333C to prevent further distal movement of the knob 333.Similarly, when the knob 333 is moved to a close position by rotatingproximally or up, e.g., toward the frame 312, the stop nut 335 canengage a distal surface of the cavity 333C to prevent further proximalmovement of the knob 333. The stop nut 335 can have a diameter largerthan a diameter of a bore in the knob 333 through which the shaft 330Sextends, thereby preventing the stop nut 335 from passing into the boreand failing to lock the knob 333 to the shaft 330S.

In the unsecured configuration, the clamping mechanism 314 can beconfigured to be movable relative to the frame 312 in at least oneplane, as discussed above regarding the first clamping mechanism 14 a.As in the illustrated embodiment, the clamping mechanism 314 can beconfigured to slide along the frame's longitudinal axis between theframe's opposed first end 316 a and second end (not shown). A proximalportion of the knob 333 can be configured and used similar to the plate22 of the first clamping mechanism 14 a and be configured tolongitudinally slide in a groove 336 formed in the frame 312 when theclamping mechanism 314 is in the unsecured position. The clampingmechanism 314, e.g., each portion of the clamping mechanism 314 exceptthe carriage 326, in the unsecured configuration can also be configuredto rotate about the central axis 314C of the clamping mechanism 314.

In the secured configuration, the clamping mechanism 314 can beprevented from moving in the one or more planes of motion in which iswas movable in the unsecured configuration, also as discussed aboveregarding the first clamping mechanism 14 a. In the embodiment of FIGS.9 and 10, the clamping mechanism 314 can be prevented from sliding alongthe frame's longitudinal axis in the secured configuration throughmovement of the proximal portion of the knob 333 to engage a wall of thegroove 336 in which it is disposed. Tension between the carriage 326 andproximal portion of the knob 333 with the frame 312 squeezedtherebetween can thereby prevent longitudinal translation of theclamping mechanism 314 along the frame 312. The clamping mechanism 314can be prevented from rotating about its central axis 314C in thesecured configuration because a pair of springs 337 a, 337 b disposed inopposed arms 341 a, 341 b of the outer shell 328 can be compressed,thereby moving a pair of pins 337 a, 337 b respectively associated withthe springs 337 a, 337 b such that the clamping mechanism 314 cannotrotate. In the unsecured position, the pair of springs 339 a, 339 b canbe in uncompressed positions such that the pins 337 a, 337 b do notprevent rotation of the clamping mechanism 314.

FIG. 11 illustrates another exemplary embodiment of a surgical device410 including a frame 412 and first and second clamping mechanisms 414a, 414 b coupled to the frame 412. The first and second clampingmechanisms 414 a, 414 b can generally be configured and used similar tothe clamping mechanism 314 of FIGS. 9 and 10. However, in thisillustrated embodiment, rotatable knobs 433 a, 433 b of the first andsecond clamping mechanisms 414 a, 414 b have cross-shapes such that theknobs 433 a, 433 b each include a plurality of extensions 433 aE, 433 bEconfigured to ease turning of the knobs 433 a, 433 b. Although the knobs433 a, 433 b each include four rectangular-shaped extensions 433 aE, 433bE, a person skilled in the art will appreciate that the knobs 433 a,433 b can have any shape and any number of extensions having any shapesame or different from any other extension.

As mentioned above, a surgical device can include one or more modularclamping mechanisms configured to be releasably and replaceably coupledto a frame. Allowing clamping mechanisms to be selectively attached to aframe in any number can provide flexibility in a surgical procedure. Aminimum number of necessary clamping mechanisms can be selectivelyattached to the frame to reduce clutter. A surgical kit can be providedthat includes at least one frame and a plurality of different modularclamping mechanisms configured to be attached to the at least one frame,thereby allowing selection of modular clamping mechanisms of differentsizes, shapes, and configurations for attachment to the frame as desiredfor particular surgical applications. The surgical kit can optionallyinclude one or more spinal fixation elements, one or more bone anchors,one or more surgical instruments configured to be clamped by the modularclamping mechanisms, and/or other surgical tools. At least one of theframes provided with the kit can have one or more pre-attached clampingmechanisms attached thereto, the pre-attached clamping mechanisms beingmodular, non-removable from the frame but movable relative theretobetween secured and unsecured configurations, and/or non-removable fromthe frame and not movable relative thereto.

FIGS. 12-16 illustrate a modular surgical device 510 including anactuator in the form of a cross-shaped rotatable knob 533 and can beconfigured and used similar to the device 410 of FIG. 11. Although onlyone clamping mechanism 514 is illustrated in FIGS. 12-16, a personskilled in the art will appreciate that any number of modular clampingmechanisms can be attached to a frame 512 and that any number of modularclamping mechanisms can be attached to a frame coupled to any number ofnonremovable clamping mechanisms.

The modular clamping mechanism 514 includes a carriage 526 similar toother carriages described herein, but the illustrated modular clampingmechanism's carriage 526 include a hinge 527 on one side 526 a thereofand a depression 529 on an opposite side 526 b thereof. The hinge 527can have a variety of sizes, shapes, and configurations, as will beappreciated by a person skilled in the art, and can be integral with thecarriage 526, as shown in the illustrated embodiment, or it can be aseparate component. A person skilled in the art will also appreciatethat the depression 529 formed in the carriage 526 can also have avariety of sizes, shapes, and configurations and can, in anotherexemplary embodiment, be an opening formed through a side of thecarriage 526 rather than a depression indented therein.

The modular clamping mechanism 514 also includes a plate 522 similar toother plates described herein, but the illustrated modular clampingmechanism's plate 522 is attached to the carriage 526 via the hinge 527and a closure mechanism, e.g., a latch 531, hingedly attached to oneside of the plate 522 and receivable in the depression 529 formed in thecarriage. The latch 531 is shown in the illustrated embodiment as aseparate component from the plate 522 but hingedly secured thereto, butthe latch 531 can be integrally formed with the plate 522. Moreover, thelatch 531 can instead be integrally formed with the carriage 526 orhingedly secured thereto. Similarly, the hinge 527 can be integrallyformed with the plate 522 rather than with the carriage 526. As in theillustrated embodiment, the hinge 527 can be fixedly, hingedly connectedto one side 522 b of the plate 522 with a first pin 543 a, and the latch531 can be fixedly, hingedly connected to an opposite side 522 a thereofwith a second pin 543 b. A third pin 543 c can be used to help attachthe plate 522 to the knob 533.

With the modular clamping mechanism 514 in an open or unattachedconfiguration, as shown in FIG. 14, the modular clamping mechanism 514is free to be attached to the frame 512 or removed from the frame 512.To attach the modular clamping mechanism 514 to the frame 512, themodular clamping mechanism 514 can be moved to a closed or attachedconfiguration, as shown in FIGS. 12, 13, and 16, by pivoting the hinge527 to bring the latch 531 into contact with the depression 529 intowhich the latch 531 can snap, click, hook, magnetically affix, orotherwise releasably and replaceably attach. In another embodiment, thelatch 531 can be configured to fixedly attach to the carriage 526 suchthat the modular clamping mechanism 514 is not releasable from the frame512 once the modular clamping mechanism 514 is in the closedconfiguration positioned around the frame 512. A distal side of thecarriage 526 can include opposed channels or grooves 545, generallyreferred to as “grooves,” configured to engage opposed sidewalls 518 a,518 b of the frame 512. Aligned the opposed grooves 545 with the opposedsidewalls 518 a, 518 b can help ensure proper alignment of the modularclamping mechanism 514 relative to the frame 512. As a default, themodular clamping mechanism 514 can be attached to the frame 512 in theunsecured configuration, e.g., configured to move relative to the frame512.

Once the modular clamping mechanism 514 is in the closed configurationand positioned around the frame 512, the modular clamping mechanism 514can be moved between secured and unsecured configurations, similar tothat discussed above.

The frame 512 can optionally include one or more stop mechanisms 515 a,515 b at opposed first and second ends 516 a, 516 b of the frame 512 toprevent the modular clamping mechanism 514, and/or any other clampingmechanisms attached to the frame 512, from sliding off either end 516 a,516 b of the frame 512. The stop mechanisms 515 a, 515 b are shown assingular protrusions extending in a substantially perpendiculardirection from proximal and distal side 512P, 512D, but the frame 512can include any number of stop mechanisms 515 a, 515 b having any size,shape, and configuration. The stop mechanisms 515 a, 515 b are identicalin the illustrated embodiment but can be different from one another.

FIGS. 17 and 18 illustrate another exemplary embodiment of a surgicaldevice 610 including a frame 612 and a modular clamping mechanism 614coupled to the frame 612. The modular clamping mechanism 614 cangenerally be configured and used similar to the modular clampingmechanism 514 of FIGS. 12-16, but instead of having a cross-shaped knob,the modular clamping mechanism 614 includes a circular, disc-shaped knob633 similar to the knob 333 of FIGS. 9 and 10.

As mentioned above, a clamping mechanism attached to a frame can beconfigured to have an adjustable depth such that the clamping mechanismcan be movable toward and away from a side of the frame in directionsubstantially perpendicular to the frame's longitudinal axis. FIG. 19illustrates one embodiment of a surgical device 710 including adepth-adjustable clamping mechanism 714 attached to a frame 712. Thedepth-adjustable clamping mechanism 714 can be configured and usedsimilar to the clamping mechanism 314 of FIGS. 9 and 10, but a clamp 730of the depth-adjustable clamping mechanism 714 can include a shaft 730Sthat extends through a circular, disc-shaped rotatable knob 733 ratherthan terminating within the knob 733 as in the embodiment of FIGS. 9 and10. The clamp's shaft 730S can be threaded in at least a distal portionthereof and be positioned through a channel 720 of the frame 712 suchthat a longitudinal axis 730A of the shaft 730S is substantiallyperpendicular to a longitudinal axis 712A of the frame 712. First andsecond rotatable knobs 747 a, 747 b can be threaded onto the shaft 730Son opposed sides 712D, 712P of the frame 712. With the first and secondrotatable knobs 747 a, 747 b tightened against the frame's opposed sides712D, 712P, the depth-adjustable clamping mechanism 714 can be held in afixed depth position relative to the frame 712. The knobs 747 a, 747 bcan be selectively loosened and tightened to adjust a position of theshaft 730S through the frame 712 and thus a depth of thedepth-adjustable clamping mechanism 714 relative to the frame 712.

FIG. 20 illustrates another exemplary embodiment of a surgical device810 including a frame 812 and a depth-adjustable clamping mechanism 814coupled to the frame 812. The depth-adjustable clamping mechanism 814can generally be configured and used similar to the depth-adjustableclamping mechanism 714 of FIG. 19. FIG. 20 also illustrates the clampingmechanism 214 of FIGS. 8E-8G clamping a surgical instrument 840.

The devices disclosed herein can be designed to be disposed of after asingle use, or they can be designed to be used multiple times. In eithercase, however, the device can be reconditioned for reuse after at leastone use. Reconditioning can include any combination of the steps ofdisassembly of the device, followed by cleaning or replacement ofparticular pieces, and subsequent reassembly. In particular, the devicecan be disassembled, and any number of the particular pieces or parts ofthe device can be selectively replaced or removed in any combination,e.g., a housing, a proximal retractor base, etc. Upon cleaning and/orreplacement of particular parts, the device can be reassembled forsubsequent use either at a reconditioning facility, or by a surgicalteam immediately prior to a surgical procedure. Those skilled in the artwill appreciate that reconditioning of a device can utilize a variety oftechniques for disassembly, cleaning/replacement, and reassembly. Use ofsuch techniques, and the resulting reconditioned device, are all withinthe scope of the present application.

Preferably, the devices described herein will be processed beforesurgery. First, a new or used instrument is obtained and if necessarycleaned. The instrument can then be sterilized. In one sterilizationtechnique, the instrument is placed in a closed and sealed container,such as a plastic or TYVEK bag. The container and instrument are thenplaced in a field of radiation that can penetrate the container, such asgamma radiation, x-rays, or high-energy electrons. The radiation killsbacteria on the instrument and in the container. The sterilizedinstrument can then be stored in the sterile container. The sealedcontainer keeps the instrument sterile until it is opened in the medicalfacility.

It is preferred that device is sterilized. This can be done by anynumber of ways known to those skilled in the art including beta or gammaradiation, ethylene oxide, steam, and a liquid bath (e.g., cold soak).

One skilled in the art will appreciate further features and advantagesof the methods, devices, and systems disclosed herein based on theabove-described embodiments. Accordingly, the methods, devices, andsystems disclosed herein are not to be limited by what has beenparticularly shown and described, except as indicated by the appendedclaims. All publications and references cited herein are expresslyincorporated herein by reference in their entirety.

1. A surgical device, comprising: a frame having a longitudinal axisextending between opposed first and second ends; and a clampingmechanism having a central axis and being selectively movable between asecured configuration and an unsecured configuration, the clampingmechanism including a base portion configured to be selectivelypositioned and secured at a desired location on the frame along thelongitudinal axis of the frame between the first and second ends of theframe, and a clamping portion, disposed opposite the base portion,configured to selectively engage an elongate tubular element at adesired location along a longitudinal axis of the tubular element, theclamping mechanism being configured to rotate about the central axisthereof relative to the frame when the clamping mechanism is in theunsecured configuration.
 2. The device of claim 1, further comprising atleast one additional clamping mechanism.
 3. The device of claim 1,wherein the clamping portion is substantially c-shaped.
 4. The device ofclaim 3, wherein the clamping portion includes an arc equal to orgreater than about 180°.
 5. The device of claim 1, wherein the clampingportion includes a closed loop.
 6. The device of claim 1, wherein theclamping mechanism is removably and replaceably mounted to the frame. 7.The device of claim 1, wherein at least the clamping portion of theclamping mechanism is configured to move relative to the frame in adirection substantially perpendicular to the longitudinal axis of theframe.
 8. The device of claim 1, wherein the clamping mechanism in theunsecured configuration is movable along the longitudinal axis of theframe and is movable along the longitudinal axis of the elongate tubularelement, and in the secured configuration is secured at the desiredlocation on the frame, is secured at the desired location along thelongitudinal axis of the elongate tubular element, and is not rotatablerelative to the frame about the central axis thereof.
 9. The device ofclaim 8, wherein the clamping mechanism is movable along substantiallyan entire longitudinal length of the frame between the opposed first andsecond ends.
 10. The device of claim 8, wherein the clamping mechanismincludes a cam, actuated by a movable lever, the cam being configured tomove the clamping mechanism between the unsecured configuration and thesecured configuration.
 11. The device of claim 8, wherein the clampingmechanism includes a rotatable knob configured to effect movement of theclamping mechanism between the unsecured configuration and the securedconfiguration.
 12. The device of claim 1, wherein the base portion andthe clamping portion are integrally formed.
 13. The device of claim 1,wherein a distal end of the elongate tubular member is configured toreleasably mate to a bone anchor.
 14. A surgical system, comprising: aframe having a longitudinal axis extending between opposed first andsecond ends; and a first clamping mechanism having a central axis, thefirst clamping mechanism including a base portion configured to beselectively positioned and secured at a desired location on the framealong the longitudinal axis of the frame between the first and secondends of the frame, and a clamping portion, disposed opposite the baseportion, configured to selectively and releasably engage an elongateshaft of a first instrument at a desired location along a longitudinalaxis of the elongate shaft, and wherein the first clamping mechanism hasan unsecured configuration in which the first clamping mechanism isrotatable about the central axis thereof relative to the frame and ismovable relative to the elongate shaft along the longitudinal axis ofthe elongate shaft, and has a secured configuration in which the firstclamping mechanism is not rotatable about the central axis thereofrelative to the frame and is fixed at the desired location along thelongitudinal axis of the elongate shaft.
 15. The system of claim 14,wherein the clamping portion is substantially c-shaped.
 16. The systemof claim 15, wherein the c-shaped portion extends radially outward fromthe frame.
 17. The system of claim 14, wherein the first clampingmechanism in the unsecured configuration is selectively positionable atthe desired location on the frame, and the first clamping mechanism inthe secured configuration is secured at a fixed longitudinal positionalong the longitudinal axis of the frame at the desired location on theframe.
 18. The system of claim 14, wherein the first clamping mechanismincludes a cam, actuated by a movable lever, the cam being configured tomove the first clamping mechanism from the unsecured configuration tothe secured configuration.
 19. The system of claim 18, wherein the camis configured to move the first clamping mechanism from the securedconfiguration to the unsecured configuration.
 20. The system of claim14, wherein the first clamping mechanism includes a rotatable knobconfigured to effect movement of the first clamping mechanism from theunsecured configuration to the secured configuration.
 21. The system ofclaim 20, wherein the rotatable knob is configured to effect movement ofthe first clamping mechanism from the secured configuration to theunsecured configuration.
 22. The system of claim 14, wherein the firstclamping mechanism is removable from the frame.
 23. The system of claim14, wherein the first clamping mechanism is not removable from theframe.
 24. The system of claim 14, further comprising a second clampingmechanism configured to be selectively positioned at a desired locationon the frame along the longitudinal axis of the frame, and configured toreleasably engage an elongate shaft of a second instrument, wherein thesecond clamping mechanism has an unlocked configuration in which thesecond clamping mechanism is rotatable relative to the frame and ismovable relative to the elongate shaft of the second instrument along alongitudinal axis extending between proximal and distal ends of theelongate shaft of the second instrument, and has a locked configurationin which the second clamping mechanism is not rotatable relative to theframe and is at a fixed longitudinal position along the longitudinalaxis extending between the proximal and distal ends of the elongateshaft of the second instrument.
 25. The system of claim 24, wherein thesecond clamping mechanism is removable from the frame.
 26. The system ofclaim 24, wherein the second clamping mechanism is not removable fromthe frame.
 27. The system of claim 24, further comprising at least oneadditional clamping mechanism configured to be selectively positioned ata desired location on the frame along the longitudinal axis of theframe, each additional clamping mechanism being configured to releasablyengage an elongate shaft of an additional instrument configured toreleasably mate to a bone anchor inserted in the vertebra, wherein eachadditional clamping mechanism has an unlocked configuration in which itis rotatable relative to the frame and is movable relative to theelongate shaft of the additional instrument along a longitudinal axisextending between proximal and distal ends of the elongate shaft of thesecond instrument, and has a locked configuration in which it is notrotatable relative to the frame and is at a fixed longitudinal positionalong the longitudinal axis extending between the proximal and distalends of the elongate shaft of the additional instrument.
 28. A surgicalmethod for manipulating a vertebra, comprising: connecting a first boneanchor to a first vertebra; connecting a second bone anchor to a secondvertebra; positioning a spinal rod in a receiving member of the firstbone anchor and in a receiving member of the second bone anchor;connecting a first instrument to the first bone anchor; connecting asecond instrument to the second bone anchor; coupling a frame to thefirst instrument by selectively engaging a first clamping mechanismcoupled to the frame at a desired location along a longitudinal axis ofthe first instrument, the first clamping mechanism being selectivelyrotatable about a central axis of the first clamping mechanism relativeto the frame; coupling the frame to the second instrument by selectivelyengaging a second clamping mechanism coupled to the frame at a desiredlocation along a longitudinal axis of the second instrument, the secondclamping mechanism being selectively rotatable about a central axis ofthe second clamping mechanism relative to the frame; and moving theframe to manipulate the first instrument and the second instrument torotate the first vertebra and the second vertebra relative to oneanother.
 29. The method of claim 28, further comprising, prior tocoupling the frame to the first instrument, adjusting a position of thefirst clamping mechanism along a longitudinal axis of the frame betweenfirst and second opposed ends of the frame.
 30. A surgical method formanipulating a vertebra, comprising: positioning a first clamp member ata first location between opposed first and second ends of a frame;positioning a second clamp member at a second location between theopposed ends of the frame; positioning the first clamp member at a firstdesired longitudinal location between opposed proximal and distal secondends of a first instrument, the distal end of the first instrument beingmated to a first bone anchor; positioning the second clamp member at asecond desired longitudinal location between opposed proximal and distalends of a second instrument, the distal end of the second instrumentbeing mated to a second bone anchor; actuating a first actuator integralwith the first clamp member to fix the first clamp member at the firstlocation and at the first desired longitudinal location; and actuating asecond actuator integral with the second clamp member to fix the secondclamp member at the second location and at the second desiredlongitudinal location.
 31. The method of claim 30, further comprising,prior to positioning the first clamp member at the first location,releasably attaching the first clamp member to the frame.
 32. The methodof claim 30, further comprising, prior to actuating the first actuator,rotating the first clamp member about a central axis of the first clampmember relative to the frame.
 33. The method of claim 30, wherein thefirst and second bone anchors are inserted in a vertebral body.
 34. Themethod of claim 30, wherein the first and second bone anchors are eachinserted in a different vertebral body.
 35. The method of claim 34,further comprising, after actuating the first and second actuators,moving the frame to move the different vertebral bodies relative to oneanother.
 36. A surgical system, comprising: a plurality of bone anchors;at least one spinal fixation element configured to be seated in at leastone of the bone anchors; a frame having a longitudinal axis extendingbetween opposed first and second ends; and a clamping mechanism having acentral axis and being selectively movable between a securedconfiguration and an unsecured configuration, the clamping mechanismincluding a base portion configured to be selectively positioned andsecured at a desired location on the frame along the longitudinal axisof the frame between the first and second ends of the frame, and aclamping portion, disposed opposite the base portion, configured toselectively engage an elongate tubular element at a desired locationalong a longitudinal axis of the tubular element, the elongate tubularelement being configured to releasably mate to one of the bone anchors,and the clamping mechanism being configured to rotate about the centralaxis thereof relative to the frame when the clamping mechanism is in theunsecured configuration.